What Is Medical Billing and Reimbursement?

When a doctor's office performs a procedure or services and gets payment from either the patient or from an insurance provider, that is known as medical billing and reimbursement. It is an integral part of any medical office, and individuals who are certified and trained in medical billing and reimbursement most likely will always be able to find employment.

Payment

• One of the important aspects in medical billing and reimbursement is determining which party is going to be reimbursing the medical facility for the procedures performed. If a payment request is sent to the wrong area, payment can be delayed. For example, if you're injured while you're subcontracted to a government department, the government might be liable to reimburse the doctor working on you. But if the doctor's office sends the billing request to either you or your original employer, payment's not going to be forthcoming until the government gets the bill.

Coding

• Medical coding is related to medical billing and reimbursement. When a bill is sent to an insurance company or health plan, one of the ways that the company decides if they are responsible for paying for the procedure is by looking at the code on the paperwork. This code is assigned by each insurance company to conform to what they will or won't pay under the terms of a policy. This illustrates why medical billing and reimbursement is so important. If there are ten insurance companies that a doctor's office works with, there might be ten different codes for a broken arm --- a code for each company. The wrong code will delay getting reimbursement.

Skills

• The skills needed in order to work in medical billing and reimbursement include accounting, coding methods, basic anatomy and physiology, medical terminology and computer skills. In addition, you'll also need good communication skills, both for dealing with the physicians and with dealing with the insurance companies and dealing with the patients.

Education

• You'll acquire the skills needed to become a medical billing and reimbursement assistant either through a medical billing and reimbursement vocational course or through an accredited college. There are also a variety of online courses that you can attend in order to get the knowledge needed to have a career in medical billing and reimbursement. Upon completion of the course, you'll also need to pass the national billing certification exam given by the American Billing Association.